Monday, October 12, 2009

Distance No Object, We Just Don't Go There

The majority of HIV positive people in Kenya live in rural areas. Granted, the percentage of people who are HIV positive in urban areas is higher than the percentage in rural areas. But most people, perhaps as many as 80%, live in rural areas.

So why are most big NGOs, including ones who are mainly concerned with HIV, based in urban areas? In fact, most health facilities, social services, government offices and just about anything else you can think of are based in urban or semi-urban areas.

Here's an example of the ridiculousness of this phenomenon: Nairobi, the capital city, is high up and therefore not very hot. There are mosquitoes there, aplenty, but malaria is not very common. The climate is just not right for the malaria bearing mosquitoes, though there is plenty of stagnant water around to support huge colonies of insects and other disease vectors.

Yet, the highest rate of mosquito net ownership is also in Nairobi. Could this be connected to the centralization of health, social services and various benefits and amenities in the capital? It's hard to tell, but it's certainly a bizarre situation. Many, perhaps most, of the mosquito nets in this country are donated by NGOs. How do so many of them end up getting stuck in the areas where they are least needed?

Nakuru is not huge, by any means. But as it's only a few hours from the capital and has its own academic institutions, it also has many academic and social projects. There are numerous NGOs doing all sorts of things here. It has far more visible street children than the much bigger capital city but it is not the most neglected of areas, either.

But travel an hour (or less if you have your own transport) out of town and you will come across villages where people rarely see NGOs or receive any of their largess. And in these villages, there are people needlessly suffering. They have the same problems as people in villages and towns closer to the privileged areas but they do not have the means to reach those areas.

Today we saw a boy whose face is terribly disfigured from burns he received several years ago. His burns were not treated in time. When they were treated, they were not treated properly. After spending over one and half years in hospital, he now has one eye, which may also be under threat, his nose is disfigured and threatened, his mouth is deformed and, most alarmingly, his skull was fractured as a result of the medical treatment he received, the medical treatment which seems not have worked yet. And the treatment cost about the equivalent of seven years salary.

There are HIV positive people who can't afford the transport to get tested, because the testing centres are in the towns and cities. There are those who know they are HIV positive but who can't afford the transport or the costs that need to be met before they can receive the, admittedly free, antiretroviral treatment (ART). There are people who need cheap drugs and treatment that they will not receive because they are in isolated areas. Many have died because of their isolation and many more will die for the same reasons.

Even the organisation I was supposed to work for is based in Nairobi. Why? I have no idea. They have no projects there. They do have five road worthy vehicles and eight motor bikes. Why? I have no idea. I don't know when any of them last visited Nakuru. I don't think any of them in head office have ever visited the village we were in today, nor would they even have heard of it. Why? I have no idea. They don't respond to my emails and I am supposed to be working for them.



Claire said...

Maybe a logframe to make their activities, purchases etc more useful? PCD is all logframed up now and every organisation which is in any way accountable is now expected to be.
Keep on telling it like it is.

Simon said...

Thanks Claire, I have been told that the questions I am asking are none of my business so I don't think the organisation would be happy if I drew them up a nice logframe.